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State Emergency

Operations Plan (EOP)

Emergency Support Function (ESF) #8

Human Infectious Disease Plan (ESF-8: TAB C)

Ohio Pandemic Influenza Response Plan

(ESF-8: TAB C, Appendix 1)

ODH Pandemic Influenza Preparedness

and Response Plan (PIPRP)

Planning Activities

(ODH activities included in the PIPRP above)

Procedures

Second Draft March 15, 2006

References

ODH Pandemic Influenza Preparedness & Response Plan 3/15/06 Second Draft

Ohio Department of Health Pandemic Influenza Preparedness and Response

Plan

The threat of an influenza pandemic is not as much a question of if, but rather a question of when.


Table of Contents

I. INTRODUCTION

Purpose......................................................................................................................1 Plan Development ......................................................................................................1 Relationship to State Emergency Operations Plan (EOP) .........................................4 Understanding Influenza ............................................................................................5 Planning Assumptions................................................................................................6 Concept of Operations ...............................................................................................7 How to Use This Plan (PIPRP)...................................................................................8 WHO Phases of Influenza Pandemic .........................................................................9 Terms and Acronyms ...............................................................................................10

II. PREPAREDNESS Part II.A: Command, Control and Management ......................................................................12 Concept of Operations .............................................................................................12 Statutory Authority....................................................................................................13 Command and Control (Incident Command)............................................................13

EOC Management....................................................................................................13 PHCC and ESF-8 Communications .........................................................................14 Business Continuity..................................................................................................14 Continuity of Operations...........................................................................................15 On-Site Incident Management..................................................................................15 Critical Resources Management ..............................................................................16

Part II.B: Communications ........................................................................................................17 Communication Systems and Devices.....................................................................18 Information Sharing ..................................................................................................19

Part II.C: Surveillance..............................................................................................................20

Health Surveillance and Epidemiological Investigation ............................................22 Public Health Laboratory: Laboratory Testing and Analysis

Part II.D: Strategies to Limit Transmission ..............................................................................23

Educational Communication and Emergency Public Information Community .........24 Limitation on Movement (Social Distancing) ............................................................25

Limitation on Movement (Isolation and Quarantine) ................................................25

Part II.E: Vaccination and Antiviral Preparedness and Response ..........................................27

Vaccine and/or Pharmaceutical Delivery..................................................................27 Mass Vaccination/Antiviral Drugs.............................................................................28

ODH Pandemic Influenza Preparedness & Response Plan 3/15/06 Second Draft Part II.F: Community Healthcare Response............................................................................29

Emergency Medical and Other Responses..............................................................29 Medical Supplies Management and Distribution ......................................................30 Mental Health ...........................................................................................................30

Part II.G: Preparedness in Health Care Facilities ....................................................................31 Scenario One: Limited ODH Involvement in Hospital Preparedness .......................32 Scenario Two: Expanded ODH Involvement in Hospital Preparedness...................33 Part II.H: Other Support Operations ........................................................................................34 Fatality Management: Mass victim identification/mortuary services.........................35 Volunteer Management and Donations....................................................................36 Mass Care ................................................................................................................37 Environmental Health ...............................................................................................37 Animal Health Emergency Support ..........................................................................37 Part II.I: Worker Health and Safety ........................................................................................39 ODH Worker Health and Safety ...............................................................................39

Responder Operations Support................................................................................40

Part II.J: Recovery Operations................................................................................................41 Part II.K: Encourage and Enable Local Planning for Pandemic Influenza ..............................42 III. RESPONSE Part III.A Command, Control and Management ......................................................................45 Concept of Operations .............................................................................................45 Statutory Authority....................................................................................................46 Command and Control (Incident Command)............................................................46

PHCC Operation (ODH Department Operations Center).........................................47 EOC Management....................................................................................................48 PHCC and ESF-8 Communications .........................................................................49 Business Continuity..................................................................................................49 Continuity of Operations...........................................................................................49 On-site Incident Management .................................................................................50 Safety and Security ..................................................................................................50 Critical Resources Management ..............................................................................51

Part III.B: Communications.......................................................................................................52 Communication Systems and Devices.....................................................................53

Information Sharing ..................................................................................................53

Part III.C: Surveillance..............................................................................................................54 Health Surveillance and Epidemiological Investigation/ Disease Reporting and Tracking ........................................................................55 Public Health Laboratory: Laboratory testing and analysis ......................................56

Part III.D: Strategies to Limit Transmission ..............................................................................58

Educational Communication and Emergency Public Information.............................59


Limitation on Movement (Social Distancing) ............................................................59 Limitation on Movement (Isolation and Quarantine).................................................60 Mass Prophylaxis .....................................................................................................60

Part III.E: Vaccination and Antiviral Drugs ...............................................................................61 Vaccine and/or Pharmaceutical Delivery..................................................................61 Mass Vaccination/Antiviral Drugs.............................................................................62

Part III.F: Community Healthcare Response............................................................................63

Emergency Medical and Other Responses..............................................................63 Medical Supplies Management and Distribution ......................................................64 Mental Health ...........................................................................................................64

Part III.G: Preparedness in Health Care Facilities ....................................................................65 Part III.H: Other Support Operations ........................................................................................67

Fatality Management: Mass victim identification/mortuary services.........................68 Volunteer Management and Donations ...................................................................68

Part III.I: Worker Health and Safety ........................................................................................69 ODH Worker Health and Safety ...............................................................................70 Responder Operations Support................................................................................71

Part III.J: Recovery Operations................................................................................................72 IV. BUILDING ODH CAPACITY Part IV.A.: Training Needs .........................................................................................................73 Part IV.B.: Partners....................................................................................................................75 V. EXERCISING THE PLAN

Exercising the Plan...................................................................................................80 APPENDIX (Blue Notebooks) Procedures: Standard Operating Procedures (SOP)

Checklists Other Procedures

References: Book 1 Book 2

PART I INTRODUCTION


Part I: Introduction

According to the World Health Organization, an influenza pandemic occurs when a new influenza virus appears against which the human population has no immunity, resulting in several, simultaneous, epidemics worldwide with enormous numbers of deaths and illness. During an influenza pandemic, the level of sickness and death from influenza and influenza-related complications can increase dramatically worldwide. With increased rates of illness and death come indirect effects that impact the global economy and everyday life. Based on observations from previous pandemics, the Centers for Disease Control and Prevention (CDC) has estimated the economic losses in the United States associated with the next pandemic will range from approximately $71 billion to $166 billion. The level of economic loss will depend on the attack rate of the virus and the resulting sickness and death. The impact of an influenza pandemic on the health care system could be devastating. The CDC estimates in the United States a moderate pandemic could result in 90 million people becoming ill; 45 million outpatient visits; 865,000 hospitalizations; and 209,000 deaths. Given the potential for high levels of sickness and death and the significant disruption to society, the State of Ohio has joined the federal government in giving high priority to planning for the next influenza pandemic. This document represents the Ohio Department of Healths (ODH) Pandemic Influenza Preparedness and Response Plan (PIPRP). While this plan is an integral part of the overall Ohio preparation and response to an influenza pandemic, it details ODHs preparedness and response efforts and reflects how these efforts dovetail with the State of Ohios overall emergency preparedness and response plans. PURPOSE The purpose of this plan and its supporting procedures for responding to an influenza pandemic is to:

reduce morbidity; reduce mortality; minimize social disruption; and facilitate planning for recovery.

This Pandemic Influenza Preparedness and Response Plan (PIPRP) provides the framework for the ODH to prepare for, identify, respond to and attempt to control an influenza pandemic. Some of the topics addressed by the PIPRP include surveillance, emergency response, pharmaceutical delivery, communications, strategies to limit transmission, training and recovery operations. The plan also serves to make operational the Ohio Department of Healths role in Emergency Support Function (ESF)-8 under the Ohio Emergency Operations Plan (EOP). PLAN DEVELOPMENT Plan development occurred through an assessment of the federal target capabilities that applied to an influenza pandemic. The target capabilities were then combined into functional areas within the plan. Additionally, the plan was organized by World Health Organization (WHO)

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phases (see page 9), with preparedness activities identified for Phases 1 through 4 and response activities for Phases 5 and 6. Although WHO Phase 5 (large clusters but human-to-human spread still localized) is a pandemic alert phase and Phase 6 signifies the pandemic period, these two phases were both considered response phases for the Ohio Department of Health, as a designation of pandemic influenza Phase 5 would lead to response activities at the agency, including the initiation of an incident command structure. The matrix on page 3 illustrates the relationship between this plan and federal target capabilities. A. RELATIONSHIP BETWEEN FEDERAL, STATE AND LOCAL RESPONSE

This PIPRP represents the ODH planning and response to an influenza pandemic. It makes operational the ODH roles and responsibilities of the State EOP, and serves to support local response plans. Pandemic response is primarily a function of local response. This plan supports local response effort, it does not replace it. Further, federal response cannot be guaranteed, as it usually can in other types of disaster response plans. State and local government must plan to respond to their own disaster, and expect minimal or no federal response.

B. RESPONSIBILITIES FOR PLAN

This PIPRP will be maintained by ODH, Division of Prevention, Bureau of Public Health Preparedness (BPHP), in cooperation with appropriate subject matter experts from other divisions and bureaus.

C. PLAN APPROVAL AND MAINTENANCE OF THE PLAN

The original plan will be approved by the director of ODH. Subsequent revisions, unless deemed significant, will be approved by the Division of Prevention. A significant revision is one that changes a concept of operations, results in a large shift in planning and response capabilities, or results in revising more than 30 percent of the plan in a single revision.

The plan will be reviewed annually by all affected ODH bureaus, primarily: Bureau of Public Health Preparedness (BPHP); Bureau of Infectious Disease Control (BIDC); Bureau of Health Surveillance, Information and Operational Support (BHSIOS); and Bureau of Public Health Laboratories.

After review, suggested changes will be submitted to BPHP. If considered appropriate, a revision will be prepared and approved.

K K


PARTS OF ODH PANDEMIC INFLUENZA PREPAREDNESS AND RESPONSE PLAN PARTS OF ODH PANDEMIC INFLUENZA PREPAREDNESS AND RESPONSE PLAN A A B B C C D D E E F F G G H H I I J J

Command, Control &

Mgmt Communi-

cation

Surveil-lance, Epi & Lab

Strategies to Limit

Transmis-sion

Vaccination and

Antiviral Drugs

Community Health Care

Health Care

Facilities Other

Support

Worker Health

& Safety Recovery

Encourage & Enable

Local Planning

Communications X Risk Mgmt. X Community Preparedness & Participation X X Information Sharing & Dissemination X X Epi Surveillance & Investigation X X P.H. Lab & Testing X X Animal Health/ Environmental(1) X X EOC Mgmt. X Critical Resource Logistics & Distribution X X Volunteer Mgmt. & Donations X X Worker Safety & Health (2) X Public Safety & Security X X Firefighting (2) X X Citizen Protection (Evacuation and In-Place) & Mass Care (1) X X X Isolation & Quarantine X X Emergency Public Information & Warning X X Triage and Pre-Hospital Treatment X X Medical Surge X X Medical Supplies Mgmt. & Distrib. X X Mass Prophylaxis X X

X Fatality Mgmt. X X

TAR

GET

CA

PAB

ILIT

IES

Econ & Community Recovery X (1) Revised and combined (2) Adapted title for Pandemic Influenza

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RELATIONSHIP OF THIS PLAN TO STATE EMERGENCY OPERATIONS PLAN (EOP) This Pandemic Influenza Preparedness and Response Plan (PIPRP) constitutes ODHs operational plan for preparing for and responding to an influenza pandemic. This plan makes operational the ODH responsibilities in its role as the primary agency for the public health function under Emergency Support Function (ESF)-8 of the Ohio EOP. This PIPRP consists of the core planning and response elements, divided in parts or sections, and is supported by its implementing procedures. The relationship of this PIPRP and supporting procedures to the Ohio EOP; ESF-8; and in ESF-8 Tab C: Human Infectious Disease Plan and its appendix, ESF-8 Tab C, Appendix 1: Ohio Pandemic Influenza Incident Response Plan is reflected in Figure 1.

The Ohio EOP describes how Ohio residents, their property and the environment will be protected in a disaster and/or emergency. The EOP details the responsibilities that have been assigned to, and have been agreed to be met by, specific state agencies and other support resource organizations, based on their capabilities. The parts of the EOP activated to guide response and recovery are emergency-specific and implemented only when triggered by emergencies for which response exceeds local abilities.

The Ohio EOP is based upon 15 emergency support functions (ESF) which are headed by lead agencies, in coordination with support agencies, selected based on their authorities, knowledge, resources and capabilities. The ESF is the primary mechanism through which state assistance to local governments is managed during emergencies under the direction/coordination of the executive director of the Ohio Emergency Management Agency, on behalf of the Department of Public Safety and the governor.

Figure 1: Relationship of State EOP to ODH Pandemic Influenza Preparedness &

Response Plan

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The ESFs describe how specific kinds of assistance common to all types of emergencies and all phases of emergencies, preparedness, response, recovery and mitigation will be provided and which agencies will provide these specific services. Ohios ESFs correspond to those in the Federal Response Plan. The primary agency is responsible for coordinating the operations of their assigned ESF, including the activities and assignment of missions carried out by the support agencies. In addition, the EOP has support annexes (broad support) and incident annexes (germane to specific hazards/emergency events).

The Ohio EOP has three support annexes that provide guidance to ensure efficient coordination and application of the broad support categories of Donations and Volunteer Management, Financial Management and Public Affairs. Ohio EMA is the primary agency for all three support annexes. The ESF-8; ESF-8, Tab C, Human Infectious Disease Plan; and ESF-8, Tab C, Appendix 1: Pandemic Influenza Incident Response Plan, are most germane to the ODH response plan to an influenza pandemic. The latter document can be thought of as the strategic plan upon which the ODH PIPRPs description of how ODH will carry out its responsibilities is based. UNDERSTANDING INFLUENZA Influenza, commonly called the flu, is caused by the influenza virus, which infects the respiratory tract (nose, throat, lungs). Influenza viruses cause annual epidemics as well as the rare pandemic because they have the ability to change genetically. Unlike many other viral respiratory infections, such as the common cold, the flu causes severe illness and life-threatening complications in many people. In the United States, the flu season usually occurs between October and April. Every year in the United States, on average, 5 percent to 20 percent of the population gets the flu, more than 200,000 people are hospitalized from flu complications and about 36,000 people die from flu. The flu is easily spread through personal contact. People with impaired immune systems, chronic medical problems or those who are elderly are more susceptible to contracting the flu. Infection occurs through exposure to the upper respiratory fluids (droplets from coughing or sneezing, for example) of an infected person. Influenza is one of the most highly contagious of diseases that humans encounter today. The single best way to prevent the flu is vaccination. In general, anyone who wants to reduce their chances of getting the flu can get vaccinated. However, certain people should get vaccinated each year: people who are at high risk of having serious flu complications or people who live with or care for those at high risk for serious complications. Some people should not be vaccinated without first consulting a physician (e.g., those allergic to chicken eggs, those with a history of a severe reaction to an influenza vaccination and those who developed Guillain-Barre syndrome after receiving an influenza vaccination). In addition, experts recommend people do the following to lower their risk of contracting the flu:

Avoid close contact with people who are sick; If possible, stay home from work, school or errands when sick; Cover mouth and nose when coughing or sneezing; Clean hands often; and Avoid touching eyes, nose or mouth.

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Influenza A virus is unique in that it can infect a variety of animals. Wild birds are the natural reservoir for influenza A. New influenza strains typically circle the globe within three to six months of emergence. New strains circulate each year, changing slightly from prior strains (called antigenic drift) so that healthy adults have partial immunity to new strains. Each year the virus, its genes in constant flux, typically makes healthy people sick, but is generally not deadly. Now and then, often several times in a century, the virus changes enough through reassortment (called antigenic shift) that there is no partial immunity in the population. This event, an influenza pandemic, results in severe illness and death, even in healthy people. The extent and severity of illness, and the disabling impact on healthy young people, could cause serious disruptions in services and social order. By definition, a pandemic (Greek, for of all the people) is a global outbreak of disease. During the past century, three influenza pandemics caused excess sickness, death and societal burden throughout the world. The "Spanish influenza pandemic of 1918 killed more than 500,000 people in the United States and perhaps 50 million worldwide. The 1918 pandemic was notorious for its predilection for healthy, young adults. In 1957, Asian influenza caused approximately 70,000 deaths in the United States. During the Hong Kong pandemic in 1968, deaths in the United States were estimated at 34,000, with 51 million Americans affected by influenza and a total economic burden of $3.9 billion. PLANNING ASSUMPTIONS 1. Illness and death can be minimized by having a comprehensive plan in place. 2. A pandemic will occur; the unknowns are time, extent, amount of warning and origin of the

novel virus. 3. In our mobile society, multiple geographic areas may be affected simultaneously,

incapacitating large numbers, including those responsible for both health and non-health related emergency services.

4. Shortages of essential resources will occur (e.g., pharmaceutical supplies for influenza as well as other chronic diseases, reagents for diagnostic services, life-saving equipment, hospital beds, decontamination and sterilization facilities and protective equipment, morgue sites and refrigerated storage for bodies and perishable resources).

5. Given the shortages of essential medical resources, changes in the usual standards of medical care will be required. Rather than doing everything possible to save every life, it will be necessary to allocate scarce resources in a different manner to save as many lives as possible. Altered standards of care may include providing medical care without the usual equipment and trained personnel that are currently used in todays pre-pandemic status.

6. Critical to this response and its effectiveness will be the cooperative and coordinated efforts of many people and organizations within the public and private sectors.

7. There are a number of assumptions regarding influenza vaccine during a pandemic: a. It is unlikely an influenza vaccine specific to the pandemic strain will be available at the

beginning of a pandemic, as the current production process for influenza vaccine takes several months and is dependent on a limited number of vendors. Once a novel virus is identified, it may take several months before vaccine is available for distribution.

b. If and when vaccine is available, it is expected individuals will need an initial priming dose followed by a second dose about 30 days later.

c. The first vaccine produced probably will be purchased by the federal government and distributed to state agencies to vaccinate priority groups.

d. With the assumption only a small percentage of the total vaccine need will initially be available to begin vaccination, not everyone will be able to receive vaccine when it first

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becomes available. ODH maintains a prioritization scheme for early vaccination in accordance with CDC recommendations.

e. If and when vaccine first becomes available, it may take months for pharmaceutical companies to produce an adequate supply of vaccine for the entire U.S. population.

f. CDC will likely develop a standard vaccine information sheet (VIS) that details the risks and benefits of the disease and the vaccine.

g. Since prior influenza vaccination(s) may offer some protection (even against a novel influenza variant), the annual influenza vaccination program, supplemented by pneumococcal vaccination, when indicated, will remain a cornerstone of prevention.

8. The federal government will assume primary responsibility for: coordinating national and international disease surveillance and developing an adverse event surveillance system; assessing need for and scope of a vaccine liability program; developing a central information database; and providing information templates for state use and guidelines for curtailing transmission.

9. Legal authority will be in place for addressing the variety of concerns precipitated by the pandemic itself and the Pandemic Influenza Preparedness and Response Plan (PIPRP).

10. Continued Ohio Department of Health preparedness for an influenza pandemic will occur within usual agency structures while response activities to a pandemic will occur within an incident command structure.

11. Local health districts must plan for a self-contained response with limited help from the state or federal government.

CONCEPT OF OPERATIONS 1. Command and control for the ODH PIPRP will be executed through the ODH Incident

Command System (ICS). Internally, the ICS will oversee ODH response activities and department operations and manage priorities and business continuity/business resumption functions.

2. An Area Command approach will be employed by the State Emergency Operations Center (EOC) to manage multiple jurisdictions and coordinate activities of all state agencies. Senior ODH management staff will be part of this Area Command organization separate from this response plan and from the ODH ICS.

3. ODH will employ a department operations center, called the Public Health Command Center (PHCC) to conduct operations and control its public health responsibilities and activities.

4. The ODH ICS will be conducted in the ODH Command Post; this post is collocated with the PHCC to facilitate communications and coordination of activities.

5. The PHCC will be led by the ODH Incident Command (ICS) Operations section chief, who oversees the operation with a PHCC manager. The PHCC will coordinate ODH-specific activities and will remain in constant communication with the State EOC through ESF-8. The PHCC will act as the ODH liaison to the State EOC, through ESF-8, and will also direct the department activities of ODH as requested through ESF-8.

6. The EOC will assist ODH in leading the public health responsibilities of the states response to an influenza pandemic. The PHCC will coordinate the activities of its public health support role and the support ODH needs from other state agencies through the State EOC.

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7. Remediation efforts will span all World Health Organization (WHO) pandemic phases

(please see the chart on page 9) and will require the continued coordination of public and private sector, medical and non-medical and volunteer organizations by the State. Interactions between state agencies will follow the procedures established in the Ohio Emergency Operations Plan (EOP), with additional coordinating relationships as delineated in ESF-8, ESF-8, Tab C: Human Infectious Disease Plan, and the ESF-8, Tab C, Appendix 1: Pandemic Influenza Incident Response Plan.

8. Pandemic influenza response activities are outlined by pandemic phase. Evolution of the pandemic will be identified and declared by the federal government as the phases described below.

9. Modified to meet the demands of each of these phases, the components of the PIPRP will function throughout the pandemic.

HOW TO USE THIS PLAN This version of the PIPRP is a second draft that will be the basis for subsequent revisions based on experience and new information. The PIPRP is a living document that is intended to be used as a useful tool for subsequent revision. The following examples of the tabular formats in which the activities are arrayed differ for Part II (Preparedness) and Part III (Response) to reflect anticipated differences in the operating environments. PART II.J (PREPAREDNESS PLAN) FORMAT FOR ACTIVITIES Activity

Responsible Program or Individual

Estimated Completion Date

1. Adapt the ODH DR/BR Plan (under development) for a pandemic influenza event.

SMG Audit Unit

Summer 06

PART III.J (RESPONSE PLAN) FORMAT FOR ACTIVITIES Activity


FOR ICS USE:

Assigned/ Completed

( ) 1. Follow the ODH DR/BR Plan for an influenza

pandemic (to be developed during interpandemic-pandemic alert period).

SMG

Division and Bureau level programs identified as being responsible for a particular activity and completion dates in Part II may be revised by those with authority to do so, or filled in where there were no entries in this second draft. Part III, which will take place in an ICS structure should be used by the Operations Chief and his or her designees as he or she deem appropriate.

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WORLD HEALTH ORGANIZATION (WHO) PHASES OF INFLUENZA PANDEMIC In 2005, the World Health Organization (WHO) Secretariat published updated guidance for an influenza pandemic and defined the phases of a pandemic. This schema provides guidance to those involved in public health, medical and emergency preparedness to respond to threats and the occurrence of an influenza pandemic. In addition, the guidance can assist governments in the development of national pandemic influenza preparedness plans. The new definitions place more emphasis on pre-pandemic phases when pandemic threats may exist in animals or when new influenza virus subtypes infect people but do not spread efficiently. In the United States, pandemic phases will be defined based on the global phase. During the pandemic phase (Phase 6), additional subdivisions may be defined based on the extent of disease. In addition, the distinction between the various phases of an influenza pandemic may be blurred or occur in a matter of hours, again underscoring the need for flexibility. The WHO phases of pandemic follows:

WHO Global Pandemic Phases (WHO Global Influenza Preparedness Plan, 2005)

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TERMS AND ACRONYMS AAP American Academy of Pediatrics

ACEP American College of Emergency Physicians

ACF Alternate Care Facility

ACIP Advisory Committee on Immunization Practices

BEH ODH, Division of Prevention, Bureau of Environmental Health

BIDC ODH, Division of Prevention, Bureau of Infection Disease Control

BPHL ODH, Bureau of Public Health Laboratory

BPHP ODH, Division of Prevention, Bureau of Public Health Preparedness

BSL Biosecurity Level

CDC U.S. Centers for Disease Control and Prevention

CMS Centers for Medicare and Medicaid Services (USDHHS)

DAS Ohio Department of Administrative Services

DHHS (U.S.) Department of Health and Human Services

DMORT Disaster Mortuary Operations Response Team (regional)

EAP ODH, Employee Assistance Program

EDRS Electronic Death Registry System

EMA Emergency Management Agency

EMS Emergency Medical Services

EOC Emergency Operations Center

EOP Emergency Operations Center

ESF Essential Security Function

FDA (US) Food and Drug Administration

FDMAOH Funeral Directors and Morticians Association of Ohio

GETS Government Emergency Telecommunications Service

GIS Global Information System

HAN Health Alert Network (Ohio)

HR Office of Human Resources (ODH)

ICS Incident Command System

ILI Influenza-like Illness

IND Investigational New Drug

JIC Joint Information Center

LHD Local Health District

LTCF Long Term Care Facility

MARCS Multi-Agency Radio Communication System

MRT Mortuary Response Team (Ohio)

NDMS National Disaster Medical System

OAC Ohio Administrative Code

OCC Ohio Citizen Corps

OCSC Ohio Community Service Council

ODA Ohio Department of Agriculture

ODH Ohio Department of Health

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IMPACT ODHL Ohio Department of Health

Laboratory SIIS Immunization Registry

SITREP Situation Report (EOC) ODNR Ohio Department of Natural Resources

SMG Strategic Management Group (ODH) ODPS Ohio Department of Public

Safety SNS Strategic National Stockpile

OEMA Ohio Emergency Management Agency SOP Standard Operating Procedure

SOSTF State of Ohio Security Task Force

OEPA Ohio Environmental Protection Agency

USDA U.S. Department of Agriculture OHA Ohio Hospital Association

USPHS United States Public Health Service

OLRNS Ohio Laboratory Response Network System

VAERS Vaccine Adverse Events Reporting System

ONA Ohio Nurses Association

OPHCS Ohio Public Health Communication System WHO World Health Organization

WPS Wireless Priority Service ORC Ohio Revised Code

OSMA Ohio State Medical Association

PHCC Public Health Command Center

PHP&R Public Health Preparedness and Response

PHRST Public Health Regional Surveillance Team

PHT Public Health Team

PICC Pandemic Influenza Coordinating Committee (of the SOSTF)

PIO Public Information Officer

PIPRP Public Health Preparedness and Response Plan (ODH)

POD Point of Dispensing Site

PPE Personal Protective Equipment

RODS Real-time Outbreak Disease Surveillance

RSS Receipt, Store, and Stage

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PART II PREPAREDNESS

The plan is organized according to World Health Organization (WHO) phases. Section II is the preparedness plan, consisting of activities to be accomplished during WHO Phases 1-4. If the influenza virus currently of worldwide concern (H5N1) is the source of the next pandemic, we are now in Phase 3. If, however, another virus causes the next influenza pandemic, we are in Phase 1. This uncertainty makes it impossible to link most activities with a specific WHO Phase. The preparedness plan will be executed through normal ODH structure (e.g., Divisions, Bureaus) rather than through Incident Command Structure (ICS). Although WHO phase 5 (large clusters but human to human spread still localized) is a pandemic alert phase and phase 6 signifies the pandemic period, these two phases were both considered response phases for ODH, since a designation of pandemic influenza phase 5 would lead to response activities at the agency, including the initiation of an incident command structure.


Part II.A: Command, Control and Management

Target Capabilities: EOC Management; Critical Resources Logistics; Information Sharing

INTRODUCTION The ODH Incident Command System has two essential roles in response to an influenza pandemic:

ODH-specific operational role; and Overall State strategic role.

ODH authority is determined by whether the objective is purely an ODH public health role, or if it is a statewide strategic role. This Pandemic Influenza Preparedness and Response Plan (PIPRP) principally describes ODHs operational role in ODH-specific response. The statewide strategic response is detailed in the Ohio Emergency Operations Plan (EOP), Emergency Support Function (ESF)-8; and in ESF-8, Tab C, Human Infectious Disease Plan and its appendix, ESF-8, Tab C, Appendix 1: Ohio Pandemic Influenza Incident Response Plan. A portion of the present ODH-specific PIPRP operationalizes ODHs role at the State EOC, to include staffing and management of communications with ESF-8 at the EOC.

CONCEPT OF OPERATIONS 1. Command and control for the ODH PIPRP will be executed through the ODH Incident

Command System (ICS). Internally, the ICS will oversee ODH response activities and department operations and manage priorities and business continuity/business resumption functions.

2. An Area Command approach will be employed by the State Emergency Operations Center (EOC) to manage multiple jurisdictions and coordinate activities of all state agencies. Senior ODH management staff will be part of this Area Command organization separate from this response plan and from the ODH ICS.

3. ODH will employ a department operations center, called the Public Health Command Center (PHCC) to conduct operations and manage its public health responsibilities and activities.

4. The ODH ICS will be conducted in the ODH Command Post; this post is collocated with the PHCC to facilitate communications and coordination of activities.

5. ODH Incident Command (ICS) will be led by the Operations section chief, who oversees the operation with a PHCC manager. The PHCC will coordinate ODH specific activities and will remain in constant communication with the Ohio EOC through ESF-8. The PHCC will act as the ODH liaison to the State EOC, through ESF-8, and will also direct the department activities of ODH as requested through ESF-8.

6. The State EOC will assist ODH in leading the public health responsibilities of the States response to an influenza pandemic. The PHCC will coordinate the activities of its public health support role and provide the support needs of other state agencies as requested through the State EOC.

7. Interactions between state agencies will follow the procedures established in the State EOP.

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STATUTORY AUTHORITY Ohio Revised Code (ORC) Chapters 3701, 3707 and 3709 and Ohio Administrative Code (OAC) Chapter 3701-3 provide authority to ODH and local health districts (LHDs) with respect to human infectious diseases. O.R.C. 3701 deals with the authority of ODH, and O.R.C. 3707 and 3709 deal with the authority of local health boards and districts, respectively. The authority of ODH and LHDs is outlined in greater detail in ESF-8, Tab C: Human Infectious Diseases Plan (formerly the Human Infectious Disease Annex). COMMAND AND CONTROL (INCIDENT COMMAND)

The ODH ICS will be organized according to the ICS Table of Organization found in Appendix A.1: ODH Incident Command Structure Table of Organization for Pandemic Influenza Response. These roles may be expanded or contracted as determined by the Incident Commander. Incident Command Organization and functions are discussed in Section III.A of this plan.

ACTIVITIES


Estimated Completion

Date 1. Develop the Pandemic Incident Action Plan

(Appendix A.2). BPHP

Done

EOC MANAGEMENT ODH leads state activities and responsibilities under ESF-8, Part 1, Public Health, in accordance with the State EOP. The ODH staff assigned to the EOC under ESF-8 will remain in constant communications with the PHCC, and will carry out the primary role of two-way communication and coordination of ODH activities between the EOC and the PHCC.

Upon the request of the Ohio Emergency Management Agency (Ohio EMA), ODH will provide a representative to the State EOC to serve as a subject matter expert to help the EOC respond effectively. Such a request may occur well in advance of an actual pandemic outbreak. Otherwise, prior to Pandemic Phase 6, the ODH ICS will largely determine ODH staffing of the EOC. After a confirmed human-to-human transfer of a novel influenza virus anywhere in the world (Pandemic Alert Phase 5), ODH will staff ESF-8 at the State EOC when it is activated. The director and the ODH ICS will decide whether or not the director or his designee will be present in the Executive Group of the State EOC at particular points during the pandemic. ACTIVITY



Date 1. Develop the PHCC. BPHP Summer 06 2. Develop an information sharing plan that will identify

what information (e.g., requests, intelligence, analyses that provide shared situational awareness, technical and situational) will be shared, in what format, through what means, how often, and by/to whom. (Also in Part II.B.)

BPHP Summer 06

13


PHCC AND ESF-8 COMMUNICATIONS ODH will maintain constant communications between the ESF-8 at the State EOC and the PHCC. The following communications methods will be employed:

State EOC Operations Center software to monitor and contribute to messages and mission

tracking; Telephone voice communications for more urgent matters between the EOC and PHCC; Fax or electronic mail communications for updates and daily situation reporting (SITREP);

and Any available electronic display sharing for vital information between the EOC and PHCC

(e.g., shared display of status of missions, shared display of real time disease reporting and tracking)

BUSINESS CONTINUITY The same issues that will affect the general population, business community and public services in an influenza pandemic will impact ODH. Therefore, a pandemics human toll in terms of sickness and death are likely to greatly reduce staff available to conduct ODH activities, those related to the pandemic event as well as non-event public health activities. Furthermore, reassignment to event-specific duties will diminish staff available for non-event duties. Given the same issues that affect ODH in this regard will affect all state agencies, we assume some of the business continuity decisions (e.g., working from home) will come through the Ohio Department of Administrative Services (DAS).

ACTIVITY



Date 1. Building on work already in progress for the ODH

Business Resumption/Disaster Recovery Plan (Appendix A.3), develop an ODH pandemic influenza event business continuity plan that:

a. Prioritizes agency activities; b. Determines the order in which specific

activities will be suspended or curtailed in accordance with the extent of depleted human resources; and

c. Determines the order in which specific activities will be restored in accordance with the extent of depleted human resources.

SMG

Fall 06

14


CONTINUITY OF OPERATIONS (LOSS OF FACILITY, ETC.) The loss of utilities (e.g., power, water) may render ODH headquarters unusable, comparable to the loss of infrastructure in a natural or man-made disaster. The ODH Business Resumption/Disaster Recovery Plan (under development) will address similar issues.


Estimated ACTIVITY

Completion

Date

ON-SITE INCIDENT MANAGEMENT On-site incident management is a local responsibility. Therefore, ODH does not anticipate playing a major role in this. Under the conditions of an influenza pandemic, however, one or more local health departments may be unable to carry out their responsibilities. ODH may have a support role to play in such cases.

1. Building on work already in progress for the ODH Disaster Recovery/Business Resumption Plan (BR/DRP) (Appendix A.3), develop an ODH pandemic influenza event continuity of operations plan that provides for: Contingency operations; and An alternate PHCC location

Internal Audit

Fall 06

ACTIVITY



Date 1. Develop a local health department assistance plan

which includes: Identification of local health departments that are

unable to meet their obligations due to an influenza pandemic; and

Policies and procedures for deployment and recovery of State assets.

Directors Office of Policy and Leadership Legal

Fall 06

15


CRITICAL RESOURCES MANAGEMENT Provisions must be made for adequate resources to support the needs of ODH staff who, in the event of a pandemic, may be on-site in ODH headquarters for extended hours.

ACTIVITY



Date 1. Purchase and maintain PPE (see Appendix B.1:

Critical Resources Checklist), train staff on proper PPE use, and establish a method to stockpile and replenish PPE.

BPHP Spring 06

2. Purchase and maintain necessary general materials (see Appendix B.1: Critical Resources Checklist) necessary to support ODH staff working extended hours (e.g., office supplies and equipment, food, water) and establish a method to replenish these materials.

BPHP Spring 06

3. Develop a list of vendors and after hours contact information on their availability on a 24/7 basis. This activity must be continually updated as vendors may be unable to provide materials due to their own emergencies.

BPHP Spring 06

4. Develop staffing rosters and procedures for work rules (e.g., length of shifts) under conditions of pandemic response.

HR Ongoing

IV.A: Training Needs IV.B: Support Agencies/Organizations Worksheet References

16


Part II.B: Communications

Target Capabilities: Interoperable Communication; Information Sharing INTRODUCTION Communication between ODH and all affected parties throughout the course of an influenza pandemic event is critical to the response effort. This is accomplished through a combination of communications systems and devices. The primary communications systems are:

1. Multi-Agency Radio Communications System (MARCS) MARCS is an 800 MHz radio communications system maintained by the

department of Administrative Service (DAS) and Ohio Emergency Management Agency (Ohio EMA).

2. The Ohio Public Health Communication System (OPHCS), which is an integral part of Ohios Health Alert Network (HAN).

OPHCS is a secure Web-based system that allows for rapid communication with first responders and essential health officials throughout the state via telephone, e-mail, fax, alphanumeric pagers, and sharing of information on the OPHCS Web portal. ODH is responsible for the hardware and technical support. Moreover, ODH is responsible for using OPHCS to launch health alert messages which may affect the health and well-being of Ohioans.

Other communication systems used by key ODH personnel include:

Government Emergency Telecommunications Service (GETS) cards; Cell phones; Pagers; ODH land lines; Conferencing ability; Satellite phones (when available); and Wireless Priority Service (WPS) for cell phones (when available).

Another communications issue is the sharing of critical information between the PHCC and the EOC. Educational communication with the public and targeted audiences is addressed in Part D: Strategies to Limit Transmission.

ASSUMPTIONS THAT INFLUENCE ODH ACTIVITIES 1. All LHDs have access to MARCS, OPHCS, ODH e-mail, high speed Internet and Voice-over

IP (VoIP), as well as any other necessary telecommunications equipment which may become available.

2. Technical support is available for all communication devices.

17


ACTIVITIES A. COMMUNICATION SYSTEMS AND DEVICES Activity



Date 1. Ensure MARCS knowledge and compliance (via

radio checks and training). BPHP

(Communication Staff)

Done

2. Create a one-page guide for MARCS radio operations.

BPHP (Communication Staff)

Spring 06

3. Ensure OPHCS knowledge and compliance (via alert testing, usage verification and training).


Done

4. Complete training of essential staff (once identified). BPHP (Communication Staff)

Summer 06

5. OPHCS development and support [ODH ICS & LHD pandemic influenza planning support (role structure, user accounts, collaboration space, alerting templates).


Done

6. Identify key personnel and provide communications equipment and support.


Summer 06

7. Update all communications SOPs and checklists (e.g., MARCS, OPHCS) related to the ODH PIPRP to reflect changing environments.


Spring 06

8. Maintain current and accurate contact information (HAN lists) and make available for all LHD emergency contacts (state agency and other/partners).


Ongoing

9. Pending approval, order WPS for cell phones of key personnel when service becomes available.

Summer 06 BPHP (Communication Staff)

18


B. INFORMATION SHARING

Activity



Date 1. Develop an information sharing plan to identify what

information (e.g., requests, intelligence, analyses that provide shared situational awareness, technical and situational) is shared, in what format, through what means, how often, and by/to whom? (Also in Part II.A.)

Prevention Spring 06

2. Following enhancement of the Real-time Outbreak Disease Surveillance (RODS) system for daily tracking of the pandemic (see Part II.C.), develop a GIS-based system for tracking and displaying the status of the spread of pandemic influenza in Ohio. Coordinate information sharing and display between the PHCC and the State EOC.

Div. of Prevention, (Infectious Disease Surveillance Unit)

Fall 06


19


Part II.C: Surveillance

Target Capabilities: Epidemiological Surveillance and Investigation; Public Health Laboratory Testing

INTRODUCTION ODH has a central role in detecting the introduction of a novel influenza virus strain(s) in Ohio and tracking the course of a pandemic by ensuring epidemiologic investigations are conducted rapidly and specimens are rapidly analyzed. This part consists of activities required for exposure and disease detection, tracking and reporting (Health Surveillance and Epidemiological Investigation); and laboratory confirmation (Public Health Laboratory: Laboratory testing and analysis).

All specimens received at the Ohio Department of Health Laboratory (ODHL) from clinical laboratories or local health districts in the State of Ohio are covered in this part of the plan. The entire population of the State of Ohio is covered by the public health epidemiologic investigation activity and includes the following partners:

Local health districts; Health care providers; Schools; Hospitals; and Laboratories

ASSUMPTIONS THAT INFLUENCE ODH ACTIVITIES 1. ODHL will become overwhelmed with testing requests. 2. Shortages of testing supplies will occur. 3. Upon identification of a novel influenza virus in a given health district, routine testing for its

presence may stop. 4. Testing at ODHL will occur under Biosafety Level (BSL) 3 conditions until the novel

influenza virus becomes widespread, then testing will occur under BSL 2 conditions.

ACTIVITIES

A. HEALTH SURVEILLANCE AND EPIDEMIOLOGICAL INVESTIGATION

Activity Responsible Program or Individual


Date Pandemic Phase 1 1. Update and regularly review protocols for disease

surveillance and reporting, epidemiological investigation and laboratory response (see Appendix B.2).

BIDC BHSIOS BPHL

Ongoing

20




Date 2. Coordinate and provide efficient surveillance and

information systems to facilitate early detection and mitigation of influenza and influenza-like illness (ILI) seen in Ohio (e.g., Real-time Outbreak Disease Surveillance [RODS]).

BHSIOS

Ongoing

3. Ensure ODH is available 24/7/365 to receive reports of suspect cases from local health districts (LHD).

BIDC Ongoing

4. Assist LHDs with investigation of influenza-related deaths, especially in children and young adults.

BIDC BHSIOS

Ongoing

5. Provide guidance to LHDs and laboratories participating in the Laboratory Response Network (LRN) regarding the need for timely and complete surveillance data, protocols to use for screening of cases and appropriate specimen submissions (see Appendix A.4).

BIDC BPHL

Done

6. Educate health care providers on the importance of influenza testing and reporting.

State Epi BHSIOS BIDC

Done

7. Work with LHDs to identify new sentinel sites for year-round influenza surveillance and additional sentinel sites for seasonal influenza to ensure adequate coverage.

State Epi BHSIOS BIDC (Immunization Program)

Ongoing

8. Assist LHDs to enroll schools/school districts in a surveillance program where schools/school districts report absences from ILI.

BHSIOS BIDC (Immunization Program)

Ongoing

9. Collaborate with the Ohio Department of Agriculture (ODA) to monitor animal influenza virus subtypes (i.e., highly pathogenic avian influenza in poultry, swine, waterfowl) so baseline data for interpreting information gathered during a pandemic will be available.

BHSIOS BIDC (Zoonoses Program)

Ongoing

10. Maintain relationships with adjoining states to ensure effective communication during a public health emergency.

State Epi Done

11. Ensure staff is familiar with protocols for appropriate specimen collection/submission guidance (see Appendix C.1).

Lab Ongoing

12. Enhance the RODS system for daily tracking. BHSIOS Fall 06 13. Develop or enhance an existing system to obtain

and track information daily during a pandemic on the numbers and location of newly hospitalized cases, newly quarantined persons, and number of hospitals with pandemic influenza cases.

BHSIOS Summer 07

Pandemic Phase 2 14. Continue Phase 1 activities.

21




Date 15. In accordance with the Investigation Worksheet

(see Appendix A.4), direct/conduct public health epidemiologic investigations.

BIDC Ongoing

Pandemic Phases 3 & 4 16. Continue Phase 2 activities. 17. Expand the capability of IMPACT SIIS to track

adverse events from vaccine and antiviral drugs. BIDC 8/31/06

B. PUBLIC HEALTH LABORATORY: LABORATORY TESTING AND ANALYSIS Activity Responsible

Program or Individual


Date Pandemic Phase 1 1. Maintain and disseminate protocols for appropriate

specimen collection/submission guidance (see Appendix C.1).

Lab Done

2. Develop and maintain SOP on culture and molecular methods to test for influenza.

Lab Done

3. Maintain MOU with state agency partners (e.g., OEPA, ODA) to ensure surge capacity needs for scaled-up diagnostic activity are met by cross-training personnel and keeping sufficient lab supplies on-hand (see Appendix D.1).

Lab Done

4. Provide 24/7/365 testing capability. Lab Ongoing 5. Institute surveillance for ILI among laboratory

personnel according to lab protocols. Lab Ongoing

6. Enhance laboratory-based monitoring of seasonal influenza virus subtypes through year-round surveillance.

Lab

Pandemic Phase 2 7. Instruct health care providers and clinical

laboratories to submit specimens to ODHL for viral culture and typing.

BIDC Lab

Done

Pandemic Phases 3 & 4 8. Continue Phase 2 activities. 9. Send notification through the Ohio Laboratory

Response Network System of novel virus identification to clinical laboratories.

Lab Ongoing

IV.A: Training Needs

IV.B: Support Agencies/Organizations Worksheet

References MOU with state agency partners (see Appendix D.1)

22


Part II.D: Strategies to Limit Transmission

Target Capabilities: Community Preparedness and Participation; Emergency Public Information and Warning; Isolation and Quarantine; Mass Prophylaxis

INTRODUCTION There are three categories of strategies to limit transmission of the influenza virus in a pandemic:

1. Educational communication and emergency public information; 2. Limitation on movement:

a. Social distancing; b. Isolation and quarantine; and

3. Vaccination and antiviral drugs (see Parts II.E and III.E). It will be difficult to substantially slow the spread of pandemic influenza through containment strategies because of the short incubation period for influenza, the large proportion of asymptomatic infections and the nonspecific nature of clinical illness from influenza infection. These challenges may lead to difficulty in identifying infected persons, in quarantining contacts of infected persons prior to the development of illness and in marshalling the substantial resources needed to initiate and monitor the use of isolation and quarantine. Nonetheless, use of containment measures, especially early on, may help slow the spread of a pandemic influenza virus and allow additional time for the development and use of a vaccine and the production and use of antiviral medications. The two main strategies for the prevention of transmission involve decreasing both contact between infected and uninfected persons and the probability that contact will result in infection. The availability of vaccine and the ability to immunize populations at risk will play a significant role in determining the extent of the recommendations for limiting movement.

ASSUMPTIONS THAT INFLUENCE ODH ACTIVITIES 1. ODH will provide the public, the health care system, response agencies and elected leaders

with continuous updates on the status of the pandemic outbreak, including steps response partners and the public can take to protect themselves. Information to address a number of possible scenarios will need to be prepared in advance for release timed to the status of the pandemic.

2. Subject matter experts (e.g., BIDC) and Office of Public Affairs staff will collaborate on the development of appropriate messages and products (e.g., fact sheets, FAQs, PowerPoint presentations). Public Affairs will work with external partners, including other entities and the media, to distribute the messages to the intended audiences.

3. Social distancing strategies aimed at reducing the spread of infection such as closing schools, community centers and other public gathering points and canceling public events will be implemented during a pandemic.

4. Effective isolation and quarantine will be dependent on good communication and personal behavior.

5. Quarantine will only have an effect prior to the disease being widespread.

23


6. Communication about the pandemic (including educational) will be coordinated with the Joint Information Center (JIC) beginning at Phase 5 but will largely emanate from ODHs PHCC(See Part II.A).

ACTIVITIES

A. EDUCATIONAL COMMUNICATION AND EMERGENCY PUBLIC INFORMATION Activity Responsible

Program or Individual


Date 1. Public Affairs, in collaboration with BIDC, will

develop the ODH Pandemic Influenza Communications Plan. The plan will:

a) Provide audience-specific messages timed to pandemic phases;

b) Specify the messages to be developed or secured and the frequency and manner by which the list of messages and materials will be updated;

c) Specify the appropriate communication vehicles (e.g., infoline, media [television, radio, Internet, print]) and how/when they will be used);

d) Be responsive to populations with special communication needs (e.g., homeless, elderly, nonEnglish speaking/refugees/ immigrants, deaf, blind and visually impaired, physically and mentally handicapped and individuals receiving care in staffed facilities);

e) Describe how ODH pandemic influenza communications will operate in the response phase, in accordance with ESF-15 (e.g., roles of JIC and field JIC) and the ODH Pandemic Influenza Communications Plan;

f) Identify ODHs internal crisis communication team and their respective responsibilities in Phases 5 and 6;

g) Contain a briefing book that includes news releases, fact sheets, public service announcements, talking points, PowerPoint files/printed handouts; and

h) Include template media materials and contact lists.

Public Affairs

Spring 06

2. Establish communication with PIO partners at appropriate levels (federal, state or local).

a. Share risk communication plan and discuss protocols for communicating during pandemic phase.

Public Affairs

Ongoing

24




Date 3. Ensure resources needed for communications and

PIO activities (including space, personnel and equipment) identified for various locations including Emergency Operations Center; Joint Information Center; Receipt, Store and Stage (RSS) Warehouse site and point of dispensing (POD) sites. (This is also addressed in Part II.A of this plan.)

Public Affairs

Spring 06

4. Ensure ODH spokespeople receive annual refresher training and are prepared to respond to a crisis event, including coaching on key messages, interview techniques and probable Questions and Answers.

Public Affairs

Ongoing

5. ODH Public Affairs will use the ODH Pandemic Influenza Communications Plan (see Appendix A.5) by disseminating information to increase awareness among all Ohio residents and other target groups.

Public Affairs

Spring 06

B. LIMITATION ON MOVEMENT (Social Distancing) Activity



Date 1. Research whether recommendations can be made in

advance of a pandemic regarding when schools and day care centers will be closed and when large gatherings will be canceled.

Summer 06 BIDC

C. LIMITATION ON MOVEMENT (Isolation and Quarantine) Activity



Date 1. Develop sample orders for LHDs use when carrying

out isolation and quarantine. Legal

BIDC Spring 06

2. BIDC, in coordination with Public Affairs, will share concepts and impacts of isolation and quarantine with partners (e.g., elected officials, schools, churches, retail businesses, workplaces).

BIDC Public Affairs

Summer 06

3. BIDC will assist LHDs in developing sufficient isolation and quarantine plans, as well as social distancing practices, contained in the Limitation on Movement and Infection Control Practices document (see Appendix A.6).

Summer 06 BIDC

25


D. VACCINATION AND ANTIVIRAL DRUGS

This means of limiting transmission of disease is covered in Part II.E of this plan. IV.A: Training Needs IV.B: Support Agencies/Organizations Worksheet References ODH Crisis Communications Plan (see Appendix D.2) SNS Communication Guidance (see Appendix D.3) Infoline Procedures (see Appendix D.4) Pandemic Influenza Briefing Book (see Appendix D.5) Ohio Homeland Security Communications Plan (see Appendix D.15) Joint Information Center operations guidance (see Appendix D.15) Ohio EMA Public Affairs Support Annex (ESF-15) (see Appendix D.15)

26


Part II.E: Vaccination and Antiviral Drugs

Target Capabilities: Mass Prophylaxis; Medical Supplies Management and Distribution INTRODUCTION

This part addresses the public health roles and responsibilities relating to vaccine and antiviral medication distribution as part of response activities to an influenza pandemic. While LHDs have the essential task of distributing supplies to the appropriate individuals within their jurisdiction, ODH has different responsibilities. ODH will request necessary medical supplies both from the federal government (i.e., CDC Strategic National Stockpile [SNS]) and local suppliers (in collaboration with its state agency partners), and ODH will distribute these supplies to local distribution sites (e.g., local health jurisdiction point of dispensing sites [PODS], hospitals) and to ODH staff. ODH will provide guidance regarding who should receive the supplies, especially prioritized vaccine and/or antiviral medication. ASSUMPTIONS THAT INFLUENCE ODH ACTIVITIES 1. In an influenza pandemic, the mass distribution of vaccines and/or medications, if available,

will be necessary. 2. LHDs have procedures/protocols for dispensing vaccines in mass clinics. 3. It is unlikely an influenza vaccine specific to the pandemic strain will be available at the

beginning of the pandemic, as the current production process takes several months and is dependent on a limited number of manufacturers. Once a novel virus is identified, it may be months before vaccine is available for distribution.

4. If and when vaccine is available, it is expected individuals will need an initial priming dose followed by a second dose about 30 days later.

5. When the SNS is initiated, the Governor has declared a state of emergency. 6. Antivirals for prophylaxis will not be available in sufficient quantity to distribute. 7. Distribution of antivirals for treatment will be necessary and not appropriate for mass

dispensing clinics. ACTIVITIES A. VACCINE AND/OR PHARMACEUTICAL DELIVERY Activity



Date 1. Follow ESF-8, Tab A, Strategic National Stockpile

Plan for vaccine and pharmaceutical receipt, storage and delivery (see Appendix A.7.

BIDC Done

27


B. MASS VACCINATION/PROPHYLAXIS Activity



Date Interpandemic Phase 1. In accordance with the ODH Pandemic Influenza

Communications Plan (See Part II.D of this plan), disseminate information to appropriate audiences (e.g., health care providers, police, firefighters, state and local public health workers, the public) to educate them about the prioritization of vaccine and antiviral medications.

Public Affairs

Spring 06

2. Remind health care providers and LHD partners about the importance of appropriate pneumococcal vaccination, which might protect some individuals from developing a secondary bacterial pneumonia after infection with influenza.

BIDC Ongoing

Pandemic Alert Phases 3. Develop a plan for the distribution of antiviral drugs

when treating Ohio residents (i.e., stockpiling for 25 percent of the population).

BIDC Spring 06

4. Maintain a prioritization scheme for early vaccination, in accordance with CDC recommendations.

BIDC Spring 06

5. Review modifications, if any, to interim recommendations on antiviral use in selected groups or circumstances (i.e., if CDC recommendations include different groups or if there are changes to treatment versus prophylaxis guidance).

BIDC Spring 06

6. Following completion of activity II.K.15 by the Mass Care Strike Team, add appropriate activities to this plan regarding the specific needs of various special populations with regard to vaccination and/or prophylaxis.

Summer 06 BIDC

IV.A: Training Needs IV.B: Support Agencies/Organizations Worksheet References SNS Ohio Mass Dispensing and Vaccination Statewide Guidance for Local Health Jurisdictions (see Appendix D.6) HHS Pandemic Influenza plan (see Appendix D.15) Vaccine Adverse Event Reporting System (VAERS) procedures (see Appendix D.15)

28


Part II.F: Community Health Care Response

Target Capabilities: Pre-hospital Treatment and Triage; Medical Supplies Management and Distribution

INTRODUCTION Community health care response means the response of the non-hospital medical community, including: Emergency Medical Services (EMS), primary care providers, home care agencies, long term care and other health professionals not directly affiliated with hospitals. Part F considers both the assessment and treatment of physical and mental health issues in the community. Physical treatment services are provided primarily by EMS and primary care providers prior to hospitalization (for hospitals, see Part II.G). ODHs role is primarily as a support agency under ESF-8. Mental health services relate not only to the illness, but to the effect the pandemic has on society. In this regard, ODHs interest primarily lies with the mental health issues of its own employees, which are addressed in Part II.I and III.I of this plan (Worker Health and Safety).

ASSUMPTIONS THAT INFLUENCE ODH ACTIVITIES 1. Emergency Medical and Other Responses: Nonstandard dispatch and triage criteria will

need to be applied due to tremendous demands on limited health care resources. 2. Emergency Medical and Other Responses: Response to the increased demand for

emergency medical services will require an altered approach to treatment and transport of injured or ill patients.

3. Medical Supplies Management and Distribution: ODH will not stockpile general medical supplies for use by the community during a pandemic, but ODH may stock limited supplies for internal use.

ACTIVITIES A. EMERGENCY MEDICAL AND OTHER RESPONSES Activity



Date 1. Provide LHDs with a checklist of important planning

guidance and revise, as needed. (See Part II.K of this plan).

BIDC Done

2. Develop a form/script/decision chart for use by ODH for screening telephone/e-mail inquiries from concerned Ohioans who call about possible novel influenza infection (to be Appendix A.8).

BIDC

Spring 06

29


Activity



Date 3. Share the form developed in activity 2 with LHDs and

make available to others (e.g., EMS, Ohio Association of Community Health Centers and Long Term Care Facilities), and post on OPHCS (see Part II.D.A).

Done BIDC Public Affairs

B. MEDICAL SUPPLIES MANAGEMENT AND DISTRIBUTION Activity



Date 1. Using available grant funds, build a stock of critical

resources. BIDC

BPHP Summer 06

2. (Pandemic Alert Phase 4) When directed, distribute the limited medical supplies available from state stock or SNS.

BIDC Done/ Ongoing

C. MENTAL HEALTH Community mental health care is addressed under ESF-8 by Ohio Department of Mental Health. ODH employee mental health and psychosocial considerations are addressed in Part II.I of this plan (Worker Health and Safety). IV.A: Training Needs IV.B: Support Agencies/Organizations Worksheet References Local Health Department Checklist (see Appendix D.7)

30


Part II.G: Preparedness in Health Care Facilities

Target Capability: Medical Surge INTRODUCTION

For the purpose of this plan, the term health care facilities is limited to hospitals. Non-hospital segments of the health care system are addressed in Part F (Community Health Care Response). For hospitals, the primary issue is preparation for the surge of patients who will need care in an influenza pandemic. ODH does not have regulatory authority over hospitals but does have a clear interest in their successful planning for likely medical surge in the event of an influenza pandemic. At this time, the Pandemic Influenza Coordinating Committee (PICC) of the State of Ohio Security Task Force (SOSTF) will task a workgroup to develop a concept of operations for medical surge. The workgroup will include representatives of state agencies, institutions (e.g., OHA) and providers (e.g., Ohio State Medical Association, Ohio Nurses Association, American College of Emergency Physicians, American Academy of Pediatrics). The products and discussions of the workgroup will better define the scope of ODHs role in assisting in planning for, and possibly the response to, a medical surge in an influenza pandemic. This draft of the ODH PIPRP distinguishes activities to be conducted under the current limited scope scenario and additional activities for consideration under a broader scope scenario if dictated by the SOSTF-PICC medical surge workgroup deliberations. ASSUMPTIONS THAT INFLUENCE ODH ACTIVITIES 1. There will be critical shortages of resources (e.g., staffed beds, mechanical ventilation

means, morgue facilities and areas for the receipt, screening, triaging, and processing of patients) in individual hospitals and/or regions.

2. The capacity and capability of individual hospitals and regions of the state to provide continuity of critical hospital services other than for the treatment of influenza will be greatly compromised.

3. Health care workers may be at a higher risk of exposure to the novel virus and subsequent illness than the general population.

4. Surge need in a given hospital or community may require a nonstandard approach to the use of hospital resources, possibly including the use of all space and equipment available; relaxation of qualifications and credentials; consideration of off-campus placement of patients; and expanded mortuary services capacity.

31


ACTIVITIES A. SCENARIO ONE: LIMITED ODH INVOLVEMENT IN HOSPITAL PREPAREDNESS Activity



Date 1. Participate in strategic planning on critical issues,

including: a. Alternative care sites; b. Altered standard of care; c. Stockpiling of supplies; and d. Other gaps (e.g., insurance plan changes to

permit individuals taking medications for chronic diseases to receive supply for additional months ahead of schedule).

SOSTF-PICC (Medical Surge Workgroup)

Fall 06

2. Encourage individual hospitals to plan for operating in an influenza pandemic and to participate in local planning (including fatality management), as well.

State Epi BPHP HRSA Coordinator

Ongoing

3. Distribute a planning checklist to hospitals.

BIDC BPHP HRSA Coordinator

Done

4. Assure hospitals are aware of the need to address special patient populations in their influenza pandemic plans.

Ongoing

5. Share with OHA and individual hospitals information about ODH policies and procedures that hospitals will need to understand in an influenza pandemic, including:

a. Delivery of state stocks and SNS for potentially limited quantities of antivirals and vaccine (See Part II.E. or III.E.)

b. ODH distribution of vaccine/antivirals to health care workers, including those in hospitals.

c. Requesting volunteer assistance through the Medical Reserve Corps (See Parts II.H. and III.H.)

d. Respective roles of ODHL, LHD and hospital laboratories in testing potential influenza virus samples during an influenza pandemic. (See Part III.C)

e. Use of Impact SIIS to track vaccinations. (See Part III.C)

f. ODH Information Sharing Plan (e.g., coordinating/delineating roles, schedules) (See Part II.B of this plan.)

g. Guidance for distinguishing pandemic influenza from other respiratory diseases.

BIDC Public Affairs

Spring 06

32


B. SCENARIO TWO: EXPANDED ODH INVOLVEMENT IN HOSPITAL PREPAREDNESS Activities to be Considered



Date 1. Assist hospitals in the development of their pandemic

influenza plans. BPHP

HRSA Coordinator

Ongoing

2. Following completion of Activity II.K.15 by the Mass Care Strike Team, add appropriate activities to this plan regarding the specific needs of various special populations of concern to hospitals.

BPHP HRSA Coordinator

Fall 06

3. Collaborate with the OHA to develop plans that can be used by individual hospitals to provide for real-time situational awareness of patient visits, hospital bed and intensive care needs, medical supply needs, and medical staffing needs during a pandemic.


Fall 06

4. Coordinate with OHA and Regional Medical Response Systems to develop resource database(s) including non-hospital health care facilities, health care workers, specialized equipment and outpatient service providers. Develop capability to serve as a resource for possible non-hospital medical surge assets for use in assisting in or alleviating shortages of bed capacity, equipment and staff.


Fall 06

5. Based on the guidance of the SOSTF-PICC process described in II.G.A.1 and the introduction to this part, conduct activities consistent with ODHs role in issues such as alternative care sites, altered standard of care, stockpiling of supplies and other critical gap issues.

Division of Prevention

Fall 06


33


Part II.H: Other Support Operations

Target Capabilities: Fatality Management; Volunteer Management and Donations; Animal Health Emergency Support; Environmental Health; Citizen Protection and Mass Care

INTRODUCTION ODH will provide support to a variety of state and local entities during an influenza pandemic, specifically:

1. Local registrars -- Certify the cause and manner of death and the proper and timely completion of death registrations;

2. Ohio Citizen Corps and Medical Reserve Corps - Collaborate with partners to design and operate a flexible system to maximize the availability and utility of volunteer resources (both lay and health professional) and donations in response to an influenza pandemic;

3. Local Health Districts (LHDs) -- Assemble and distribute general information, guidelines and recommendations concerning the risks of infection from animals and contaminated environments, and how to safely dispose of dead animals and decontaminate environmental areas; and

4. County Coroners -- Collaborate with partner agencies, organizations and local jurisdictions to define roles and responsibilities for fatality management.

With regard to fatality management, ODH will take a leadership role in integration with ESF-8 and coordinating activities with the operational agencies and other partners in local health and relevant associations.

ASSUMPTIONS THAT INFLUENCE ODH ACTIVITIES

1. The Electronic Death Registration System (EDRS) will be overwhelmed. ODH will act to streamline the process during a pandemic.

2. Entities or persons responsible for people with special needs will continue to be responsible for planning and providing resources for these individuals during an influenza pandemic and will need guidance about how to prepare.

3. Unknown numbers of individuals will volunteer to assist in a pandemic. Credentialing is required to assure appropriate skills, training and licensure status. It will be best to have pre-identified, pre-credentialed and trained volunteers to respond to an influenza pandemic.

4. Large quantities of material donations, both solicited and unsolicited, will be contributed and will need to be processed during an influenza pandemic.

5. ODH will receive questions and requests for information and/or recommendations from state and local agencies, the public and special interest groups concerning the risks of infection from animals and potentially contaminated environments to humans.

6. Surveillance data from federal and state agencies (e.g., U.S. Department of Agriculture [USDA], CDC, ODA, ODNR) may be an important early warning of avian influenza activity as it relates to the risk of human cases occurring.

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7. The exact roles and responsibilities of the coroner in a mass fatality event have not been

widely defined. Personal physicians and health care facility (acute and long term care) physicians will all be involved, at least in some stages, with death registrations in a mass fatality event. Other physicians who might also be involved in a mass fatality event include the local health commissioner (or medical director) as well as the medical director for Ohio EMA.

8. There may be large numbers of deaths occurring both within health care facilities and in residences.

9. In addition to death registration, local jurisdictions must have the capability to effectively perform all aspects of fatality management, of which there are many (e.g., scene documentation; complete collection and recovery of the death victims personal effects and items of evidence; decontamination of remains and personal effects).

ACTIVITIES

A. FATALITY MANAGEMENT: MASS VICTIM IDENTIFICATION/MORTUARY SERVICES Activity

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